Cognitive recovery after surgery
4.6 million people could be affected by post-operative cognitive deficits each year, according to Professor Stanton Newman
A series of lectures delivered by an academic from City, University of London in Australia has helped to raise awareness of the number of people who develop cognitive problems following surgery worldwide.
Invited by the Australian Society of Anesthetists, Professor Stanton Newman – who is Dean of the School of Health Sciences – delivered talks in Melbourne, Hobart and Adelaide about the issue.
With 230 million major surgeries carried out worldwide in 2012. While many people have a short term problem in their cognitive function after surgery a significant proportion have longer term difficulties. A conservative estimate of 2% of people having these longer term problems would suggest that annually 4.6 million people could be affected by post-operative cognitive deficits (POCD).
The cognitive problems tend to occur in the areas of attention, memory and executive functions. Particularly vulnerable to the occurrence of POCD are the elderly with the evidence suggesting that approximately 8% of those over the age of 65 who undergo major non cardiac surgery end up with POCD. There is also evidence that the presence of POCD is associated with an increased risk of post surgery mortality.
There are large individual differences and those with higher education and higher levels of intellectual ability are less likely to demonstrate POCD as it has been suggested that these individuals have a larger capacity to resist brain damage.
Following on from research carried out by Professor Newman, the talks also discussed how we can influence brain recovery. This includes:
- Avoiding unnecessary anesthesia and surgery especially in the elderly – in those over 65 a higher percentage have POCD at one week and 3 months post surgery;
- Monitoring microemboli which occur in cardiac and orthopeadic surgery and modifying techniques so as to reduce the occurrence of these bits of matter entering the brain and causing blockages in blood vessels;
- Avoiding blood transfusions where possible as they can trigger enhanced acute inflammatory responses; and
- Adequately prepare and support patients and spouses – those assigned to room with post-surgery patient had less preoperative anxiety and were discharged on average 1.4 days earlier.
The talks also discussed how we can assess cognition and POCD, with Professor Newman highlighting several neuropsychological tests that can be used to help detect cognitive deficits post surgery.
These neuropsychological assessment tools, which can be performed prior to and at various points post surgery, are used to objectively measure changes in cognitive function following surgery. Professor Newman raised the importance of ensuring that such tests used in the detection of POCD are sensitive to detect changes in cognition over time and appropriate for the detection of diffuse brain injury. An appropriate battery of tests will also cover a range of cognitive domains, including memory, attention, concentration, and perceptual and motor ability.
Professor Newman said:
“The talks were a great opportunity to speak with fellow health professionals about how we can address the pressing issue of post-operative cognitive decline and brain recovery. With millions affected by the associated conditions of POCD, and with our populations continuing to live longer and undergo more and more surgery, it is important we address this issue and develop appropriate tools and tests to inform us of its effects and examine changes we can introduce to improve outcomes for patients.”